EXCISION OF MAMMARY DUCT FOR

INTRADUCTAL PAPILLOMA

 
 

 

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How we usually manage it?

 

  

Localize the diseased duct.

1.      Applying finger pressure at varying points along the outer margin of the areola in order to determine which segment of the breast contains the offending duct.

2.      Applying collodion to the surface of the nipple to temporarily occlude all of the ducts and prevent discharges.

-          if on initial examination there is failure to elicit adequate discharge from the duct to  determine exact location. Requires subsequent examination a week later, remove collodion and repeat localization.

-          If applied one week prior to operation may cause distention of the diseased ducts and if it contains blood, its surface will display a purplish hue. This may be  easily identified intra-operatively.         

           

Operative Technique:

·        Patient supine

·        Asepsis and antisepsis technique

·        Sterile drapes placed

·        Local anesthetic (lidocaine with epinephrine)

·        An incision is made at the circumference of the areola at the area of the involved duct. Length of incision not more than 50% of areola’s circumference.

·        Use blade 15

·        Create a flap over the nipple area

·        Hemostasis

 

 

·        Identify the ducts involved (eg. presence of blood)

 

 

 

 


     
  • Excise the area of the ductal system beginning at the nipple and proceeding in a peripheral direction.
  • Ligate the involved duct and divide them from the nipple

 

 

 

 

 

 

  • dissect the ducts for a distance of 3-5cm using electrocautery until ducts disappear into the beast tissue

 

 

 

 

 

 

  • complete the excision
  • Hemostasis
  • Washing with NSS
  • Complete instrument and sponge count
  • Close the defect using Chromic 3-0 inverted T
  • Skin – Vicryl  4-0 subcuticular
  • Betadine
  • Dry sterile dressing

 

EXCISION OF MAMMARY DUCTS

HOW WE DID IT

Operative Technique:

·        Patient supine under gen mask

·        Asepsis and antisepsis technique

·        Sterile drapes placed

·        Localization of diseased duct – applying finger pressure around areola towards nipple to elicit discharge

·        Circumareolar incision made encompassing 50% circumference at area of diseased duct

·        Nipple-areola complex elevated from underlying breast tissue

·        Involved ducts identified – applying finger pressure

·        Mammary ducts completely excised from breast tissue using electrocautery

·        Mammary ducts divided from nipple attachments

·        Hemostasis checked

·        OS and instrument count

·        Closure done – subcuticularly